產後抑鬱症

吳宇琛

SUM WU

Sum Wu

Registered Chinese Medicine Practitioner

Bachelor of Health Science in Traditional Chinese Medicine (UTS)

Bachelor of Science Majoring in Psychology (UOW)

Specialising in pain management and mental wellbeing through Tradition Chinese medicine in combination with modern science in mental health, dieting and nutrition.

吳宇琛，澳洲政府註冊中醫師、針灸師，五龍崗大學心理學學士、悉尼科技大學中醫系學士，擅長用傳統針灸理傷手法和中藥治療各種新舊損傷痛症，特別採用中醫中藥和現代心理學、營養學相結合調理治療各種慢性病和亞健康。

Postpartum depression

產後抑鬱症

Postpartum depression is depression that occurs after having a baby. Feelings of postpartum depression are more intense and last longer than those of “baby blues,” a term used to describe the worry, sadness, and tiredness many women experience after having a baby. “Baby blues” symptoms typically resolve on their own within a few days.

產後抑鬱症是指生完孩子後發生的抑鬱症。產後抑鬱症的感覺比“Baby Blues” 更強烈、 持續時間更長，“Baby Blues”一詞用於描述許多女性在生完孩子後所經歷的擔憂、悲傷和疲倦，“BabyBlues ”症狀通常會在幾天內自行消失。

According to studies 1 in 5 new mums and 1 in 10 new dads suffer from PPD. Common symptoms of postnatal depression include low mood, changes in sleep and appetite, and feelings of hopelessness. The main difference PPD is different to baby blues is that the depressive periods lasts longer and is more severe and doesn’t usually go away without seeking help.

根據研究，五分之一的新媽媽和十分之一的新爸爸患有產後抑鬱症 (PPD)。產後抑鬱症的常見症狀包括情緒低落、睡眠和食欲改變以及絕望感。產後抑鬱症與baby blues的主要區別在於，抑鬱期持續時間更長、更嚴重，並且通常在不尋求幫助的情況下不會消失。

PPD affects mothers and infants the most profoundly, but it can negatively impact spouses, relationships, and other family members as well. Untreated PPD can leave a devastating aftermath which can impact the mental, physical, and emotional development of infants, as well as greatly increasing the risk of the child developing depression at some point in their lifetimes.

產後抑鬱症對母親和嬰兒的影響最為深遠，但它也會對配偶、人際關系和其他家庭成員產生負面影響。未經治療的產後抑鬱症可能會留下毀滅性的後果，影響嬰兒的精神、身體和情感發展，並大大增加兒童在一生中的某個階段患抑鬱症的風險。

In western medicine PPD is generally believed to be caused mainly by a sharp decrease in hormones such as oestrogen and progesterone酮as well as hormones produced by the thyroid gland. Other factors include genetics – similar to some other types of depression where a familiar history of the illness can increase the chances of it occurring. Emotional changes are also believed to be a factor as well. Usually a new parent is sleep deprived and overwhelmed it can cause the emotions to become unstable which can lead to a downward spiral of emotions. A more serious condition is postpartum psychosis which has much more server symptoms such as hallucinations, feelings of confusion and paranoia as well as thoughts about harming yourself or the baby.

西醫一般認為產後抑鬱症主要是由於雌激素、黃體酮等激素以及甲狀腺產生的激素急劇減少引起的。其他因素包括遺傳——類似於其他一些類型的抑鬱症，既往的病史會增加其發生的機會。情緒變化也被認為是一個因素。通常，新父母睡眠不足而且對照顧新生兒不知所措，這會導致情緒變得不穩定，從而導致情緒螺旋式下降。更嚴重的情況是產後精神病，它有更多的症狀，如幻覺、困惑和偏執以及傷害自己或嬰兒的想法。

When it comes to treatment from a western medical point of view the first step is to identify if you are at risk of developing PPD. This is generally something that is discussed with your doctor prior to planning to conceive if the mother has a history of depression. Since medication at this stage is not advised and may harm the development of the foetus we would need to focus on monitoring and screening for symptoms as well as providing counselling or going to support groups but in severe cases antidepressants may be prescribed. Following birth, the new parents can continue to seek counselling but may also start to take medication. Just last year a new oral drug called zuranolone specifically made for treating PPD was approved in the US.

從西方醫學的角度來看，治療的第一步是確定自己是否有患產後抑鬱症的風險。如果母親有抑鬱症病史，這通常是在計劃懷孕之前與您的醫生討論的事情。由於在此階段不建議使用藥物，並且可能會損害胎兒的發育，因此我們需要重點監測和篩查症狀，以及提供咨詢或參加支持小組，但在嚴重的情況下可能會開抗抑鬱藥。孩子出生後，新父母可以繼續尋求咨詢，但也可以開始服用藥物。就在去年，一種名為 zuranolone 的專門用於治療 PPD 的新型口服藥物在美國獲得批準。

This leads us to one of the main reasons people turn to TCM for treatment. The idea that modern medicine can have some harmful or unwanted side effects and in this case, fears that the drug may pass onto the infant via breastfeeding. While most of these fears are unwarranted it is always a good idea to seek complementary therapy and to keep your options opened.

這就是人們轉向中醫治療的主要原因之一。現代醫學可能會產生一些有害或不需要的副作用，在這種情況下，人們擔心藥物可能會通過母乳喂養傳給嬰兒。雖然大多數擔心都是沒有根據的，但尋求補充療法並保持選擇餘地總是一個好主意。

From the TCM perspective, PPD is due to the depleted state of Qi and Blood after giving birth which will have an impact on mental health. Generally new mothers’ to develop a mild form of depression within a few days of giving birth due to fatigue, feeding difficulties and perineal pain. While there is a term for PPD in Chinese now, there isn’t actually an equivalent in TCM. The reason is traditionally the symptoms in PPD are broken down into separate symptoms such postal natal palpitations, postal natal hysteria, postnatal attention deficit, postnatal deficient flushing and postnatal insanity. This idea is backed up by classical texts that include treatments for the above mentioned symptoms and from a modern perspective can be understood as an early definition of what PPD is today.

從中醫角度來看，產後抑鬱症是由於產後氣血虧虛，影響心理健康。一般來說，新媽媽在分娩後幾天內會因疲勞、喂養困難和會陰疼痛而出現輕度抑鬱症。雖然現在中文中有產後抑鬱症這個術語，但中醫實際上並沒有對應的術語。原因是傳統上產後抑鬱症的症狀被分解為不同的症狀，如產後心悸、產後歇斯底裡、產後注意力缺陷、產後潮紅和產後精神錯亂。這個想法得到了經典文獻的論證，其中包括上述症狀的治療方法，從現代的角度來看，可以理解為當今產後抑鬱症的早期定義。

So while western medicine uses a combination of drugs to alter the brain chemistry to either increase the levels of serotonin or limit its reuptake and to stabilise mood swings, in TCM we need to address the deficiencies, in this case Qi and Blood. Blood is vital for our mood is because the Shen which is responsible for our emotional stability requires sufficient amount of blood to remain stable. The Heart houses the mind and governs the Blood so if Heart-Blood is deficient the Heart-Shen has nowhere the settle which can lead to depressive disorders. In addition to depression and anxiety, insomnia, fatigue, inability to cope, tearfulness, low libido, anger, and guilt could occur due to blood loss.

因此，雖然西醫使用藥物組合來改變大腦化學物質，以增加血清素的水平或限制其再攝取並穩定情緒波動，但在中醫中，我們需要解決氣和血的缺陷。血對於我們的情緒至關重要，因為負責我們情緒穩定的神需要足夠的血液來保持穩定。心主神，主血，心血不足，心神無處安定，就會導致抑鬱症。除了抑鬱和焦慮之外，失血還可能導致失眠、疲勞、喪失應對能力、流淚、性欲低下、憤怒和內疚。

Postpartum complication can include continuous bleeding as well as Liver, Spleen and Stomach disharmonies which in turn can manifest as dizziness, dry mouth, spontaneous perspiration, light-headedness, tinnitus, emotional instability, irritability, abdominal pain, aversion to cold, fever, and poor appetite.

產後並發症包括出血不止，肝、脾、胃不和，表現為頭暈、口乾、自汗、耳鳴、情緒不穩、煩躁、腹痛、惡寒、發熱、沒胃口等。

And if we look back to western medicine, blood lost can lead to anemia which results in iron deficiency and is a common symptom of people suffering from PPD. Studies have found that low hemoglobin count during pregnancy is normal and levels should rise back up within 3-5 days postpartum but in the case of those who show early signs of PPD, this level remains low so an iron supplement may be recommended to the new mother to reduce the severity of PPD symptoms.

回到西醫，失血會導致貧血，即缺鐵，這是患有產後抑鬱症的人的常見症狀。研究發現，懷孕期間血紅蛋白計數較低是正常現象，其水平應在產後 3-5 天內回升，但對於那些表現出 PPD 早期跡象的人，該水平仍然較低，因此可能會建議產婦補充鐵劑用來減輕 PPD 的症狀。

When someone is Blood deficient they may present with a pale face, pale lips, pale fingernails and a sallow appearance are the results of the blood’s inability to nourish the skin. At this stage we would need to counter the effects by tonifying the Blood and Qi. A common tradition is to cook a lot of tonifying soups such as Bu Zhong Yi Qi Tang or BA Zhen Tang for the new mother as well as herbal teas such as Shen Hua Tang to help the body expel any lingering bruise blood or clots as well as help the blood to circulate for some examples.

血虛的人會出現臉色蒼白、嘴唇蒼白、指甲蒼白、面色蠟黃等現象，這是血液不能滋養皮膚的結果。這個階段就需要通過補血補氣來對抗。常見的傳統是為新媽媽煮大量補中益氣湯或八珍湯等滋補湯，以及生化湯等草藥茶，以幫助身體排出殘留的瘀血或血塊來幫助血液循環。

We can use TCM to diagnose the symptoms that may occur in someone suffering from PPD and through the combination of the 5 element theory the 5 Shen and the 7 Emotions we can begin to identify the root cause of these symptoms and the effectively apply the proper treatment.

我們可以使用中醫來診斷患有產後抑鬱症的人可能出現的症狀，並通過五行理論、五神和七情的結合，我們可以開始識別這些症狀的根本原因，並有效地採取適當的治療。

如有疑問想咨詢吳宇琛中醫師，可以在微信或whatsapp搜索0404836368，加吳宇琛中醫師微信或whatsapp，也可以發短信或致電0404836368作語音留言，吳宇琛中醫師有空就會回復。